The cancer patient: communication and morale.

Brewin, Thurstan

doi:10.1136/bmj.2.6103.1623

Cited by 65 publications

(25 citation statements)

References 4 publications

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“…Our opinion is that a specific preparation for physicians dealing with terminal patients cannot be purely theoretical [6]. Our data confirm the involvement of personal factors in the physician/patient relationship [16], which is even more evident than the influence of professional factors.…”

Section: Discussionsupporting

confidence: 87%

Physicians and death: Comments and behaviour of 605 doctors in the north-east of Italy

Annunziata

Talamini

Tumolo

et al. 1996

Support Care Cancer

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The aim of this study was to determine the influence of socio-demographic and professional factors on physicians' attitudes to the terminally ill. Between May 1992 and May 1993, a survey was conducted in the province of Pordenone (north-east, Italy) in order to analyse a number of specific issues, such as emotional involvement, the need for aggressive treatments and the communication of diagnosis and prognosis. After obtaining a list of board-certified physicians from the Medical Association office in Pordenone, a modification of the cancer questionnaire of Haley and Blanchard (QSPT) was mailed to 916 doctors. Of these, 605 (60%; 487 male, 118 female; mean age 41 +/- 11 SD) returned the completed questionnaire. Within the group of responders, we identified three main subgroups, according to their type of activity: general practitioners (175, 29%), hospital doctors (235, 39%) and other doctors (195, 32%). In age, sex and activity, the only significant difference between responders and non-responders was age (mean age 41 and 43 years respectively). Most of the responders (77%) stated that they were able to deal with the terminally ill patient and his/her needs; 44%, however, admitted that patients' anxiety is sometimes unbearable. For the vast majority of the doctors polled (91%), providing a comfortable environment for an incurable patient was more important than pursuing aggressive treatment, but only 44% were convinced of the uselessness of aggressive care. To the question on whether to disclose information about imminent death to allow patients to prepare spiritually, 37% answered "No", 38% "Yes", and 25% were uncertain. Almost all responders (95%), however, believed in the beneficial effect of hope on the terminally ill. Our results suggest that doctors' professional and, most of all, socio-demographic and cultural factors determine the relationship with the patient on both the emotional and the clinical decision-making levels.

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Section: Discussionsupporting

confidence: 87%

Physicians and death: Comments and behaviour of 605 doctors in the north-east of Italy

Annunziata

Talamini

Tumolo

et al. 1996

Support Care Cancer

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“…The cancer patient himself will often indicate when and what sort of information he wants, and a listening approach is recommended (2,8). Every question the patient asks should be honestly answered, but information should not be forced on him.…”

Section: Communicationmentioning

confidence: 99%

“…While the specialist has the advantage of first-hand knowledge of all the benefits and sideeffects of the treatment, the practitioner probably knows the patient and his family better. At this stage of the disease "efficient and immediate interprofessional communication should not only be good, but seen by the patient to be good" (2).…”

Section: During Treatmentmentioning

confidence: 99%

“…The information for cancer patients should ideally be based upon a planned, continuous process and should be careful, phased and individual. Planned information means that doctors, nurses and other health-workers involved should discuss and decide together what to say and how and when to tell.The cancer patient himself will often indicate when and what sort of information he wants, and a listening approach is recommended (2,8). Every question the patient asks should be honestly answered, but information should not be forced on him.…”

mentioning

confidence: 99%

“…Anxiety accompanies most cancer patients, even those with an excellent prognosis (1). Patients who feel they are not being told enough are often "suffering from a feeling of insecurity" (2).…”

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confidence: 99%

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The General Practitioner and Information to Cancer Patients

Nylenna

1985

Scandinavian Journal of Primary Health Care

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Information to cancer patients is a continuous process, and a considerable personal undertaking is usually needed. The general practitioner is in an unique position because of his contact with the cancer patient and his family during all stages of the diseaes. This gives him both opportunities and the responsibility for this information.The basis for cancer patient information can briefly be given in the "three c's": Communication, Coordination and Cooperation-communication both to patient and family and coordination and cooperation between the multitude of professionals, who often take care of the cancer patient right through his illness. Key words: geneml practice, patient infonnorion, cancer.M. Nylenna, Institute of General Practice, Fr. Stangsgate 11/13, 0264 Oslo 2, Norway.It has been said that knowledge is the antidote to fear, and probably no other disease is so closely related to fear as cancer. Anxiety accompanies most cancer patients, even those with an excellent prognosis (1). Patients who feel they are not being told enough are often "suffering from a feeling of insecurity" (2).Most of the studies of cancer patient information have been done in hospital since this setting is normally where the diagnosis is made and the prognosis discussed (3).Studies show that most cancer patients want to be informed of their disease (3-7). However, it has been observed that this wish declines with progressing disease (8). Over the last 10-20 years there has been a change in the attitudes of the doctors in this field (9). More cancer patients are now told both diagnosis, prognosis and treatment alternatives, and most physicians no longer protect their patients by not giving them information. There are perhaps many reasons for this change: improving therapy and better prognosis, a general increase in public awareness of cancer, less stigmatization of cancer, better consumer attitudes to the health professions and more consciousness about "patients' rights" (10).The general practitioner plays an important role in this information. Usually the general practitioner represents the patient's entry to the health care system, and for most patients he also is the symbol of continuity. The general practitioner will have the best knowledge of the patient's total situation. In addition he is often the only available source of information when questions arise. COMMUNICATIONCommunication is the keyword to any information. The information for cancer patients should ideally be based upon a planned, continuous process and should be careful, phased and individual. Planned information means that doctors, nurses and other health-workers involved should discuss and decide together what to say and how and when to tell.The cancer patient himself will often indicate when and what sort of information he wants, and a listening approach is recommended (2,8). Every question the patient asks should be honestly answered, but information should not be forced on him. It has been shown that good patient-communication may be rarer than one would thin...

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Psychological Aspects of Cancer Surgery: Surgeons' Attitudes and Opinions

Burton

Parker²

1997

Psycho-Oncology

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Fifty‐one surgical consultants, registrars and senior registrars in NHS hospitals in the West Midlands (UK) were interviewed about psychological aspects of cancer surgery: information given to patients, the bad news interview, psychological risk factors in surgery, psychiatric morbidity, difficult patients, and care of the dying. Information that tended to be provided infrequently included the cause of the disease, the effects of surgery on sexual functioning, and psychological side‐effects of the surgery. Surgeons most often answered incompletely patients' questions about prognosis, effects of surgery on sexual functioning, the presence of malignancy, and probable length of life. Concerning the disclosure of malignancy, 37% said they always tell the patient; 8% tell virtually all patients; 49% tell the patient depending on the patient's and relatives' wishes; and 6% tell the relatives and possibly the patient. A common strategy among 49% is to use the word ‘growth’ and wait for the patient to ask further. Few surgeons took even the briefest psychiatric history, and only the most severe post‐operative psychological complications were referred to psychiatrists. The most difficult patients for surgeons to manage were emotionally labile, angry, demanding, controlling, refusing treatment, or predicting failure. The surgeons in this sample clearly struggled with their role as giver of bad news and with the consequent emotional reactions of the patient. © 1997 John Wiley & Sons, Ltd.

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The cancer patient: communication and morale.

Cited by 65 publications

References 4 publications

Physicians and death: Comments and behaviour of 605 doctors in the north-east of Italy

Physicians and death: Comments and behaviour of 605 doctors in the north-east of Italy

The General Practitioner and Information to Cancer Patients

Psychological Aspects of Cancer Surgery: Surgeons' Attitudes and Opinions

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